Erjan Ayah, Almasri Hanan, Abdel-Razeq Hikmat, Al-Masri Mahmoud, Haddad Hussam, Alnsour Anoud, Rahman Fadwa Abdel, Dayyat Abdulmajeed
Department of Radiation Oncology, 37559King Hussein Cancer Center, Amman, Jordan.
Department of Medicine, 37559King Hussein Cancer Center, Amman, Jordan.
Cancer Control. 2021 Jan-Dec;28:10732748211004889. doi: 10.1177/10732748211004889.
Metaplastic breast cancer (MetBC) represents a therapeutic challenge. We evaluated the impact of clinicopathological characteristics and treatment modalities on outcomes among MetBC patients treated at our center.
Women with stage I-III MetBC were reviewed from our database from 2005-2018. Kaplan-Meier method was used to calculate locoregional-failure-free survival (LRFFS), overall-survival (OS) and distant-metastases-free survival (DMFS). We assessed associations with survival outcomes by log-rank tests. Multivariate Cox proportional-hazards models were used to identify independent predictors of LRFFS, OS and DMFS.
81 patients were eligible for the study. Median age at diagnosis was 48 years. 90.1% had G-III tumors, 64.2% were pathologically node negative and lympho-vascular invasion (LVI) was absent in 72.8%. 67.8% were triple negative, and 7.4% were HER2-neu positive. Most (66.7%) patients underwent mastectomy. Free margins were achieved in the entire cohort, however, 17.3% had close margin (<2 mm). Almost all patients received chemotherapy. 75.3% received radiotherapy, 23.5% received hormonal therapy and 6.2% received Trastuzumab. With a median follow-up of 54 months, 18.5% developed loco-regional recurrence and 34.6% relapsed distally. Five-year OS was 66.0%. On multivariate analysis: adjuvant radiotherapy correlated with better OS ( < .0001), and tumor size >5 cm, nodal involvement and LVI correlated with worse OS, ( = .019, = .021, = .028, respectively). There were no survival differences with respect to age, triple negativity, and morphologic subtype.
We report the largest single institutional series on MetBC in the Middle East region. MetBC confers worse survival outcomes, and more aggressive local and systemic treatment strategies should be investigated.
化生性乳腺癌（MetBC）是一项治疗挑战。我们评估了临床病理特征和治疗方式对在我们中心接受治疗的MetBC患者预后的影响。
对2005年至2018年我们数据库中I - III期MetBC女性患者进行回顾。采用Kaplan - Meier方法计算局部区域无复发生存率（LRFFS）、总生存率（OS）和远处转移无复发生存率（DMFS）。我们通过对数秩检验评估与生存结局的相关性。多变量Cox比例风险模型用于确定LRFFS、OS和DMFS的独立预测因素。
81例患者符合研究条件。诊断时的中位年龄为48岁。90.1%为G - III级肿瘤，64.2%病理检查淋巴结阴性，72.8%无淋巴管侵犯（LVI）。67.8%为三阴性，7.4%为HER2 - neu阳性。大多数（66.7%）患者接受了乳房切除术。整个队列均实现了切缘阴性，但17.3%的患者切缘接近（<2 mm）。几乎所有患者都接受了化疗。75.3%接受了放疗，23.5%接受了激素治疗，6.2%接受了曲妥珠单抗治疗。中位随访54个月，18.5%发生局部区域复发，34.6%发生远处复发。五年总生存率为66.0%。多变量分析显示：辅助放疗与更好的总生存率相关（<0.0001），肿瘤大小>5 cm、淋巴结受累和LVI与更差的总生存率相关（分别为=0.019、=0.021、=0.028）。在年龄、三阴性和形态学亚型方面生存无差异。
我们报告了中东地区最大的关于MetBC的单机构系列研究。MetBC的生存结局较差，应研究更积极的局部和全身治疗策略。
